Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1960-035 | WI |
NPI | 1215996723 |
---|---|
Provider Name | Dr. Steven Lee Nottleson |
First Address | Green Bay, WI 54313-6204 |
Second Address | Marinette, WI 54143-1334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 03/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1871667220 | GROUP NPI (01) | |
38523200 | (05) | WI |
39-1548019 | TAX ID (01) | |
DG8179 | GROUP PTAN (01) | |
U32085 | (02) |